Provider Demographics
NPI:1831865591
Name:SMITH, JESSICA LYN (LMSW)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LYN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6385 CHASSE KNL
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77632-1507
Mailing Address - Country:US
Mailing Address - Phone:919-900-0373
Mailing Address - Fax:
Practice Address - Street 1:6385 CHASSE KNL
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77632-1507
Practice Address - Country:US
Practice Address - Phone:919-900-0373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty